clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.24411/2588-0519-2019-10064clinvest-438Research ArticleФАРМАКОЭПИДЕМИОЛОГИЯPHARMACOEPIDEMIOLOGYРаспространённость назначений потенциально не рекомендованных лекарственных средств в практике ведения пациентов пожилого и старческого возрастаPrevalence of potentially inappropriate medications among elderly patients in clinical practiceАль-РаджавиА.Al-RajaviA.

аспирант кафедры общей и клинической фармакологии

Москва

Postgraduate Student, Department of General and Clinical Pharmacology

Moscow

alirajawi4075@gmail.comhttps://orcid.org/0000-0002-6348-6867ЗыряновС. К.ZyryanovS. K.

SPIN-код: 2725-9981

д. м. н., профессор, зав. кафедрой общей и клинической фармакологии

Москва

SPIN-code: 2725-9981

MD, professor, Head of Department of General and Clinical Pharmacology

Moscow

https://orcid.org/0000-0001-7729-2169УшкаловаЕ. А.UshkalovaE. A.

д. м. н., профессор кафедры общей и клинической фармакологии

Москва

MD, PhD, professor of the Department of General and Clinical Pharmacology of the Medical Institute

Moscow

БутрановаО. И.ButranovaO. I.

к. м. н., доцент кафедры общей и клинической фармакологии

Москва

PhD, associated professor of the Department of General and Clinical Pharmacology

Moscow

https://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

к. м. н., научный сотрудник лаборатории клинической фармакологии и фармакотерапии,

ОСП РГНКЦ, член Российской ассоциации геронтологов и гериатров (РАГГ)

Москва

PhD, Researcher of the Laboratory of clinical pharmacology and pharmacotherapy, Russian Clinical and Research Center of Gerontology, Member of the Russian Association of Gerontologists and Geriatricians (RAGG)

Moscow

Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов»РоссияPeoples’ friendship university of RussiaRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов», Государственное бюджетное учреждение города Москвы «Городская клиническая больница № 24 Департамента здравоохранения города Москвы»РоссияPeoples’ friendship university of Russia, State Budgetary Institution of the City of Moscow «City Clinical Hospital No. 24 of the Moscow City Health Department»Russian FederationФГБОУ ВО РНИМУ им. Н.И. Пирогова Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian Federation201922072019016573Copyright © Аль-Раджави А., Зырянов С.К., Ушкалова Е.А., Бутранова О.И., Переверзев А.П., 20192019Аль-Раджави А., Зырянов С.К., Ушкалова Е.А., Бутранова О.И., Переверзев А.П.Al-Rajavi A., Zyryanov S.K., Ushkalova E.A., Butranova O.I., Pereverzev A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/438

Актуальность. Рациональная и безопасная фармакотерапия пациентов пожилого и старческого возраста осложняется полиморбидным состоянием большинства пациентов, что ведёт к полипрагмазии. Использование инструментов, направленных на выявление возможного назначения потенциально не рекомендованных лекарственных средств (ПНЛС) (критерии Бирса, STOPP / START) позволяет повысить безопасность фармакотерапии пациентов пожилого и старческого возраста. Цель работы состояла в определении распространённости назначений ПНЛС в популяции пациентов ≥65 лет на амбулаторном и стационарном этапах и в выявлении факторов, ассоциированных с назначением ПНЛС в указанной популяции пациентов. Материалы и методы. Дизайн работы — ретроспективное фармакоэпидемиологическое исследование, включавшее данные медицинской документации 401 пациента ≥65 лет, проходившего лечение в стационарах в сроки с 1 июня по 30 декабря 2017 года. Статистический анализ включал методы параметрической и непараметрической статистики и многофакторный анализ. Результаты. Средний возраст — 77,4 ± 7,18 года. Медиана сопутствующих заболеваний составила 3 (IQR 0—5). Среднее число назначений лекарственных препаратов на одного пациента составило 2 (IQR, 0—4). 37,4 % пациентов получали ≥5 препаратов. Использование критериев STOPP-2 обнаружило 239 эпизода назначения ПНЛС у 33,4 % пациентов. Не было выявлено корреляции между возрастом, полом и частотой назначения ПНЛС (р=0,356 и р=0,718 соответственно). Многомерный регрессионный анализ назначений ПНЛС обнаружил высокую ассоциацию с сахарным диабетом ([95 %ДИ] 28,168 [12,548, 63,230]; p = 0,000) и гипертонией (OR [95% CI] 2,698 [1,637; 4,448]). Выводы. Использование критериев STOPP-2 показало практическую распространённость назначения потенциально не рекомендованных лекарственных средств, особенно выраженную в отношении фармакотерапии сердечно-сосудистых заболеваний. Наиболее распространёнными препаратами, идентифицированными в качестве ПНЛС, были вазодилататоры, аспирин и антигистаминные препараты первого поколения. Была установлена ассоциация между частотой госпитализаций, наличием сопутствующих заболеваний и назначение ПНЛС. 

Actuality. Rational and safe pharmacotherapy of patients in elderly and senile age is complicated by the polymorbidity of the majority of patients resulting in polypharmacy. The use of tools to identify prescription of potentially inappropriate medications (PIMs) (Beers criteria, STOPP / START criteria) helps to increase the safety of pharmacotherapy in elderly and old age patients. The objective of this work was to determine the prevalence of PIMs in out- and inpatients population ≥65 years old and to identify associated with PIMs factors. Materials and methods. Retrospective pharmacoepidemiology study of medical records of 401 patients ≥65 years old who were hospitalized in the period from 1st of June to 30th of December, 2017. Statistical analysis included methods of parametric and non-parametric statistics and multivariate analysis. Results. The average age was 77.4 + 7.18 years. The median of comorbidities was 3 (IQR 0—5). Th e average number of drugs prescribed per patient was 2 (IQR, 0—4). 37.4 % of patients received ≥5 drugs. The use of STOPP-2 criteria revealed 239 episodes of PIMs in 33.4 % of patients. No correlation was found between age, sex, and PIMs (p = 0.356 and p = 0.718, respectively). Multivariate analysis of PIMs demonstrated a high association with diabetes mellitus ([95 % CI] 28.168 [12.548, 63.230]; p = 0.000) and hypertension (OR [95 % CI] 2.698 [1.637, 4.448]). Conclusions The use of STOPP-2 criteria has shown the practical prevalence of PIMs especially for pharmacotherapy of cardiovascular diseases. The most common drugs identifi ed as PIMs were vasodilators, aspirin, and fi rstgeneration antihistamines. An association was shown for the hospitalizations rates, the presence of comorbidities and PIMs.

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Polypharmacy and Potentially Inappropriate Medication Use as the Precipitating Factor in Readmissions to the Hospital. J Family Med Prim Care. 2013 Apr-Jun; 2(2):194—199.

The authors declare that there are no conflicts of interest present.